Health care reform policy debate affects seniors
Summary: The health care policy options under debate could reduce costs and dramatically improve quality of long-term health care for seniors.
On Wednesday, Members of the Senate Finance Committee will debate health care policy options aimed at making the health care delivery system more effective and efficient. Many of the proposed options have a high potential to benefit the long-term care of seniors.
The policy options, released by Senate Finance Committee Chairman Max Baucaus (D-Mont.) and Ranking Member Chuck Grassley (R-Iowa), would create incentives for health care providers to focus on high quality care and to closely coordinate with a patient’s other doctors and providers. This is important for seniors who seek care from multiple doctors and risk doubling up on prescriptions that could have harmful interactions.
The proposed health care policy revisions, which will be debated in a closed-door hearing, also target changes in how private insurance companies bill Medicare patients, and are intended to reduce fraud, waste and abuse in the Medicare system.
The following details, as released by the Senate Finance Committee, reveal aspects of the health care policy options that would have a dramatic impact on seniors who receive continued care for chronic illness:
Promoting Quality Care: Medicare currently reimburses health care providers on the basis of the volume of care they provide. For every test, scan, or procedure conducted, providers
receive payment – regardless of whether the treatment contributes to helping a patient recover. Medicare must move to a system that reimburses health care providers based on the quality of care they provide. The policy options would shift Medicare from volume‐based purchasing to value‐based purchasing. Under value‐based purchasing, Medicare would provide new payment incentives for care that contributes to positive patient outcomes. The policy options would establish a value‐based purchasing program for hospitals starting in fiscal 2012, direct CMS to develop plans to establish value‐based purchasing programs for home health and skilled nursing facility providers by 2012, strengthen and expand programs that will eventually lead to value‐based purchasing for doctors, reduce inappropriate ordering of imaging services like CT scans and MRIs, and start inpatient rehabilitation and long‐term care hospital providers on a path toward value‐based purchasing program.
Promoting Primary Care: Primary care doctors are vital to reducing costs and improving quality in the health care system. Primary care doctors provide preventive care, help patients
make informed medical decisions, serve a critical care management role and help coordinate with other doctors. Despite their critical function, primary care doctors receive significantly
lower Medicare payments than other doctors, which has led to a shortage of primary care doctors. To encourage more primary care doctors to be part of the system, the policy options would provide primary care practitioners and targeted general surgeons with a Medicare payment bonus of at least five percent for five years, and provide Medicare payment to primary care practices that provide specific transitional care services for beneficiaries with high costs, chronic illnesses.
Fostering Care Coordination and Provider Collaboration: Today, many doctors want to spend more time working together, but report that current payment systems often discourage care coordination. When providers in different settings, like doctor’s offices, hospitals, nursing homes, and rehabilitation facilities work together, patients can get well sooner and costs in the
system are lower.
Chronic Care Management:To encourage chronic care management, the policy options will foster innovation by allowing broad‐scale Medicare pilot programs of patient‐centered care
coordination models for the chronically ill that improve quality and reduce spending, and allow preliminary rapid‐cycle Medicare testing of evidence‐based care management and coordination models across various settings to determine best models for success.
Provider Collaboration:To encourage hospitals and other health care providers to work together, the policy options will provide Medicare payment incentives to hospitals that reduce
preventable hospital readmissions, and provide a single bundled Medicare payment for acute and post‐acute episodes of care.
Payment for Accountable Care:To incentivize providers to improve patient care and reduce costs by offering patients access to care at a wide range of health care providers and settings, the policy options would address the impending cuts to physician reimbursement rates, allow high‐quality providers to share in savings they achieve to the Medicare program through increased collaboration, and expand Medicare participation in community‐level health care delivery system reforms.
Quality Measure Development: The policy options will focus on quality measure development by requiring the Department of Health and Human Services to partner with stakeholders to
develop a national quality improvement plan and encouraging development of next generation quality measures that are aligned with delivery system reform goals like, for example, measuring
care coordination for chronically ill.
Health Care Workforce: Ensuring America’s health care system has a sufficient supply of health care professionals to meet the demands of a changing and aging population is essential to
maintaining focus on high‐quality, cost efficient care. To strengthen the health care workforce, the policy options would increase graduate medical education training positions for
primary care and implement other immediate modernizations to the Medicare GME program, and develop a proposal that requires Health and Human Services to work with external
stakeholders to develop and implement a national workforce strategy, in conjunction with the Senate Health, Education, Labor and Pensions Committee.
Medicare Advantage: Private insurers that participate in Medicare should bring value to the program and to beneficiaries. Health care reform should ensure payments to private insurers in the Medicare Advantage program bring high quality, efficient plans into the Medicare program. The policy options would use current measures to pay plans for quality improvement, change statutory benchmarks or set benchmarks based on competitive plan bids, provide a bonus payment to Medicare Advantage plans that use evidence‐based programs to manage care of the chronically ill, and allow plans to continue to offer extra benefits, but reducing wide variation among plans.
Combating Fraud, Waste and Abuse: Reducing fraud, waste, and abuse in Medicare will reduce costs and improve quality throughout the system. The Medicare improper payment rate
for 2008 was 3.6 percent, or $10.4 billion, and the National Health Care Anti‐Fraud Association estimates that fraud amounts to at least three percent of total health care spending, or more
than $60 billion per year. The policy options combat fraud, waste and abuse by enhancing the review of health care providers prior to granting billing privileges, leveraging technology to
better evaluate claims, educating providers to promote compliance with program requirements, monitoring programs more vigilantly, and penalizing fraudulent activity swiftly and sufficiently.
Caregiverlist provides a helpful breakdown for individuals trying to better understand what Medicare covers.